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Home My WebLink About1000-141.-4-22 g 4 , TOWN OF SOUTHOLD x j 0331 Owner Andrew McGowan III & Ors Occupied as Single Family Dwelling Located at 560 Pacific Street Mattituck 141-4-22 Maximum Permitted Occupancy 2 Is in compliance with all of the provisions of the code of the Town of Southold, the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. Expiration is two (2) years from date of issue. The operator is responsible for arranging for the bi-annual inspection. 9/23/2021 ` Code Eofor ent Official This Notice must be posted by the main entrance at all times Town Hall AnnexTelephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD _ RENTAL PERMIT APPLICATION Rental Permit Fee 200(Application must be renewed every two ears Section A. Property Information: Rent„ l Prpperty Ad ess� Tax Ma Number: J� Map 1000 SECTION -BLOCK LOT 2Z° SECTION B. OWNER INFORMATI 41 Property Owner Name: Property Owner Legal Address: Property Owner Mailing Address: mff I k_ r - 2 Telephone Number(s): Daytime Evening Emergency r 3 � Property Owner Email Address: Page 1 of 5 Town Hall Annex N'N '� Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 i Jill ,P BUILDING DEPARTMENT TO" OF SO OLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address: Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address: SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: Address of Managing Agent (no P.O. Boxes): Page 2 of 5 Town Hall Annexi Telephone(631)765-1802 54375 Main Road Jr Fax (631)765-9502 P.O.Box 1 179 �� " ' Southold,NY l 1971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening Emergency Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier(for example, Unit 1, Unit 2, Unit 3 or Apt A, B, Q the use of each room in the Rental Dwelling Unit (for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimensions of each room. For properties with multiple Rental Dwelling Units use "Rental Permit Application Addendum." Rental Dwelling Unit Identifier: Requested Maximum number of persons all wed to occupy Dwelling Unit:. Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit:.,6LIlkk Page 3 of 5 Town Hall Annexe Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 C: ,p r Southold,NY 11971-0959 `' h BUILDING DEPARTMENT TOWN OF SOUTHO SECTION G. INSPECTION: Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Properties), a safety inspection by Code Enforcement Official is required. If the owner chooses not to have said inspection performed by the Town, a certification from a licensed architect, a licensed professional engineer or a home inspector who has a valid New York State Uniform Fire Prevention Building Code Certification is required stating that the property which is the subject of the rental permit application is in compliance with all of the provisions of the code of the Town of Southold,the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ 1 am submitting a completed Town of Southold certification form from a licensed architect or a licensed professional engineer. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COU T1P"OF SUFFOLK) 1 certify under penalty of perjury,the following: 1. 1 am the owner of the property identified in "Section A" of this application. 2. The property owner's legal address set forth in "Section B" of this application is my legal address and I understand the Town will use the address for service pursuant to all Page 4 of 5 Town Hall Annex Telephone(631)765-1802 54375 Main Road ;r Fax(631)765-9502 P.O.Box 1179 ,`� Southold,NY 11971-0959 1` BUILDING DEPARTMENT TOWN OF SO OLD applicable laws and rules. I further acknowledge that I will notify the Town of Southold Building Department of any changes of address within five (5) days of any changes thereto, 3. 1 have read and received a copy of Chapter 207 of the Code of the Town of Southold and agreed to abide by the same. 4. 1 will notify the Town within five (5) business days as to any change to the information regarding Authorized Agent Managing Agent, or Site Manager. Property Owner's Name Property Owner's Signature: tv Sworn to before me this L25 ay of AU us+_ 200 Official Notaro5ublic Signature 4d Original Notary Stamp TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,28aq�,_ Page 5 of 5 "f Town Hall Annex SOUTHOLD TOWN 54375 Main Road `< PO Box 1179 Southold, Rental Inspection NY 11971-1179 Tel: 631-765-1802 r Fax 631-765-9502 SCTM # C I _ c _ Z Date Z. Owner (� ol�u Phone Address o i eWZip Hamlet 2 (JC.K Inspector Address visible from street? LEVELS SUB 1 2 3 Smoke Detectors (#-bedroom detectors excluded) Carbon Monoxide Detectors(#) Fire Extinguishers (#) Exits (#) BEDROOMS 1 2 max,,.. 3 4 _5 Smoke Detector Alarms (#) Carbon Monoxide Alarms (#) Egress (windows) (WN) BUILDING SYSTEMS CONDITION OF PROPERTY N Heating system maintained/operational Building Interior is clean/maintained Hot water system maintained/operational Building Exterior is clean/maintained Electrical system maintained/operational Property is clean/safe/maintained Mechanical system maintained/operational Handrails&guards present POOLS Ori i2 Y/N POOL BARRIERS Y/N Pool present r Pool is completely enclosed Pool surface alarm and/or door alarm Barrier is a min. 48" high resent POOL GATES Y/N All openings in barrier less than 4" Self-closing, self-latching Max. 2"clearance @ bottom of barrier Latch on pool side of gate, meets height Barrier capable of being locked&child- requirements proof when unattended COMMENTS: w °� ... SZ1.1 1`" t cr �� =.1 rLm c� s . w �.� m �� a �. ret m Y X r rS N m ry J, at\ i r IF i MSM o m � I CD y h. v r m 7a 4A Z CD < m < Co ' w,a dr d Tm Z Z L m m Gl Gl X C= W Z d � & pIN m y Kh 1 b N r — � f jff M '^w iii 4k V � j4a } f r � b � d yy Igy y � h c a 7—, TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, NEW YORK CERTIFICATE OF OCCUPANCY NONCONFORMING PREMISES Date: July 18, 1984 THIS IS TO CERTIFY that the Pre C.O. #Z12611 Land /X/ Building(s) F/ Use(s) located at 560 Pacific Streel—LI.O.W.1 Mattituck Street Hamlet shown on County tax map as District 1000, Section 141 .00, Block 04 .00 L,ot 022.000 , doesLnot)conform to the present Building Zone Code of the Town of Southold for the following reasons: Insufficient total area. Insufficient fro t & sidp var,dWarea . Nrr_ conforming second dwelling with insufficient side & backyard setbacks. On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming /�/Land /�/Building(s) /_/Use(s) existed on the effective date the present Building Zone Code of the Town of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to the Building Inspector's Office, the occupancy and use for which this Certifi- cate is issued is as follows: A one story wood framed one family dwelling and a one story wood framed cottage. The Certificate is issued to Rob (owner, kty1exRRxtf_k"C) of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CER'T'IFICATE NO. N/A NOTICE IS HEREBY GIVEN that the owner of the above premises I-LAS NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec- tor to determine if the premises comply with all applicable codes and ordin- ances, other than the Building Zone Code, and therefore, no such inspection has been conducted. This Certificate, therefore, does not, and is not intended to certify that the premises comply with all other applicable codes and regula- tions. r - . Dw.3 din ..._.,,....� -- ..._.... � ;„r�9pG'CtOr w. —. . . �......._. ��rFF�t ,gym, Town of Southold 8/6/2020 .,lP.O.Box 1179 53095 Main Rd €' Southold,New York 11971 r1 . ..._ CERTIFICATE OF OCCUPANCY No: 41328 rvW Date: 8/6/2020 THIS CERTIFIES that the building ELECTRICAL Location of Property: 560 Pacific St,Mattituck SCTM#: 473889 Sec/Block/Lot: 141.4-22 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 7/8/2020 pursuant to which Building Permit No. 44955 dated 7/8/2020 — _........ ......... was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: pa bit electrical algrgde ami an ex st coggg, The certificate is issued to Radiant Gems Ltd of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44955 8/5/2020 PLUMBERS CERTIFICATION DATED __...... ..... : ...... r P Authorized Signature O O CD 0 E " o 000 _ 0 m CD N a Q " O_ v- �. an h CL N o to m N n' o N " OCD cn Q o h O E3 V 5 CD CL CD cv <. n o cn o X in CD y � o 3. CCD z -a z CD C=D ' o < n CD (D CD m o -1 M 0 0CD 3 CD n o m O o n CD 0 -,, m =r .�. Q- cu cm CD C� (2. �' '�cn � o =3 Q) (CD a H "'S Q COQ ✓ i Q 1 CD cr 1 CL C- W 0 m O �+ o � ,p z CD� tn. � O 3 N M X N o 0 W u,- o V6